Understanding Preeclampsia: A Guide for Preeclampsia Awareness Month

Published: May 28, 2024

May is Preeclampsia Awareness Month, an annual event that promotes improved healthcare practices as they relate to preeclampsia. Patients are encouraged to share their experiences, and researchers, clinicians, and legislators are encouraged to prioritize preeclampsia research. The Preeclampsia Foundation, which leads a month-long campaign about the hypertensive disorder every May, named the 2024 theme ‘Predict Prevent Prevail.’ 

Texas Collaborative for Healthy Mothers and Babies (TCHMB) — the state’s perinatal quality collaborative that comprises healthcare providers, scientists, hospitals, state agencies, advocates, and insurers — developed Understanding Preeclampsia: A Guide for Preeclampsia Awareness Month to support improved care and outcomes for preeclampsia patients in Texas.

Defining Preeclampsia 

Preeclampsia is a life-threatening condition that affects 5-8% of pregnant patients, characterized by elevated blood pressure (BP) and, at times, elevated protein in the urine (proteinuria). It may be accompanied by other symptoms, including chest pain, abdominal pain, liver problems, headaches, and changes in vision.  

Alone, each of these symptoms does not indicate preeclampsia, but it’s important for pregnant patients to report these symptoms and any existing conditions to their healthcare provider. Some conditions put pregnant patients at a higher risk of developing preeclampsia: 

  • A woman who has never delivered a baby
  • Type 1 or Type 2 diabetes
  • History of hypertension
  • 35 years or older
  • Teenager (under 20)
  • Chronic medical conditions, including kidney disease or Lupus
  • Preeclampsia/hypertension in a previous pregnancy
  • Twin pregnancy

                Diagnosing Preeclampsia 

                Providers will diagnose preeclampsia when a patient meets the following conditions: 

                • Been pregnant for at least 20 weeks 
                • Reported systolic BP of 140 or higher -or- diastolic BP of 90 or greater 
                • On at least 2 occasions that are at least 4 hours apart 

                    A diagnosis of preeclampsia can be given with or without the presence of proteinuria.

                    Treating Preeclampsia 

                    The course of action following a preeclampsia diagnosis depends on the stage of pregnancy. In most cases, a patient confirmed to have BP greater than 140/90 will be sent for an initial evaluation at a hospital, where providers will monitor BP, collect laboratory tests including a urine test for proteinuria, and assess for symptoms of preeclampsia. 

                    Treatment for Preeclampsia Based on Stage of Pregnancy

                    Between 24 and 33 weeks 

                    The goal is to get the pregnancy to 34 weeks, with the decision to deliver based on: 

                    • Presence of severe features, e.g., severe range BP, persistent headache, visual disturbances, or abdominal pain 
                    • Gestational age 
                    • Laboratory results 

                    If there is no evidence of preeclampsia with severe features, the management is discharging the patient and closely following up as outpatient.  

                    If severe features are present, the patient may remain under observation in the hospital undelivered, with plans to deliver if symptoms worsen or deliver at 34 weeks if symptoms respond to treatment. 

                    At or beyond 37 weeks 

                    The management is delivery.

                    To prevent preeclampsia in patients at risk, doctors will prescribe a low-dose aspirin at around 16 weeks of gestation.

                    Developing Recognition and Response to Postpartum Preeclampsia in the Emergency Department (PPED), a TCHMB Quality Improvement (QI) Project 

                    11% of pregnancy-related deaths are related to preeclampsia/eclampsia, with 50% of those deaths occurring in the first six weeks (42 days) after delivery, according to the Texas Maternal Mortality and Morbidity Review Committee and Department of State Health Services Joint Biennial Report 2022. Consequently, it is important for the public to recognize preeclampsia symptoms, which can occur not only during pregnancy but also during the postpartum period. 

                    Based on this data — and because so many patients who experience preeclampsia symptoms visit the emergency room — TCHMB developed the PPED QI project. This initiative aims to reduce maternal morbidity and mortality related to severe hypertension in postpartum patients by increasing the collaboration between obstetric and emergency departments with: 

                    • Enhanced screening for postpartum status 
                    • Education on diagnosis, treatment, and follow-up care in the emergency department

                    Latest Research and Future Directions 

                    Research into preeclampsia has recently focused on understanding its underlying causes, with particular attention to the placenta’s role. While the exact cause remains elusive, ongoing studies are investigating inflammatory components and antibodies that may contribute to the condition. Experts predict that within the next decade, advancements in this area will provide valuable insights into prediction and prevention strategies. 

                    Clinical Review 

                    Special thanks to the following healthcare professionals for contributing their expertise to this article: 

                    • James Hill, MD, the Obstetrics Committee Co-Chair for TCHMB and the Division Chief for the Division of Maternal-Fetal Medicine at Baylor College of Medicine/The Children’s Hospital of San Antonio. Previously, he was a Field Artillery officer and retired Colonel in the United States Army and a mathematics professor at West Point. 
                    • Susan Dimitrijevic, BSN, RNC-NIC, the Senior Nurse Program Manager for TCHMB. For the past 25 years, she has focused her nursing career on Neonatal Intensive Care, caring for critically ill infants and their families. Before joining TCHMB, she was the Neonatal Program Manager and Clinical Nurse Manager of the Level NICU Transport team at Dell Children’s Medical Center. 

                    Written by Kirsten Handler, Communication Specialist at UTHealth Houston School of Public Health in Austin. 

                    TCHMB is funded by the Texas Department of State Health Services.